What is it going to take? When will people get the message? When will people understand and listen?
I’ve stopped posting on social media about COVID-19 because it feels like so many people aren’t listening, and it is like banging your head on a wall.
But I see so many posts about people still defying the health recommendations. I see posts of people saying things like, “No one is going to tell me how many people I can have in my home for the holidays,” or “I refuse to wear a mask because it takes away my rights,” or “We need to fully open all businesses because our economy is struggling.” Or, “It’s just a flu, most people recover and the numbers are inflated anyway,” or “I refuse to live in fear,” or “We need herd immunity.”
I see posts of people having parties. I see posts of parents letting their children have sleepovers. I see posts of people traveling. I see posts of people going to more places than necessary at a time when being out and about should be limited because the more places you go, no matter how careful you think you are being, you are increasing your risk of contracting this virus.
While I see all these posts, I am witnessing firsthand our hospital filling up with sick COVID-19 patients. I see the intensive care units in my hospital experiencing a tremendous increase in the number of COVID-19 patients requiring critical care and mechanical ventilation. I have been a critical care nurse for almost 15 years and I have never felt this physically, emotionally and mentally exhausted — and all of that is intensified by realizing that, after all of these months, people still aren’t listening.
People of all ages
When I started my clinical rotation in the ICU for my nurse practitioner program in August, we were down to two COVID-19 patients in the ICU with only one of those on a ventilator. We had one general medical surgical unit with only a handful of noncritically ill COVID-19 patients admitted.
Now the medical ICU COVID-19 side is full; over the weekend, seven of our 16 trauma ICU beds were occupied by COVID-19 patients, five of whom were on ventilators. By the end of my third 12-hour shift in a row, one of those patients was near death and died later that evening. We now have four medical units for COVID-19 patients not requiring critical care but still requiring hospitalization. The emergency department is overwhelmed, and the rapid response team is constantly being called to patients who are in severe respiratory distress.
And while we have learned how to better treat these patients and recovery rates are increasing, we are still losing lives to this virus. I see patients dying who don’t have multiple comorbidities, even as people insist this disease is only taking the lives of the immunocompromised and already ill. I am seeing young patients in their 20s, 30s, 40s, 50s and 60s on full oxygen support struggling to breathe and requiring intubation and mechanical ventilation, when people are saying this is only happening to the elderly. I am seeing people of all ages losing their lives to this virus.
Fear and hope
I’ve had to watch a patient’s oxygen level drop to the low 80s — the normal level is at least 95% — on the monitor as I peer through the glass door to his room in the ICU, watching him as he struggles to breathe with the maximum amount of oxygen we can provide before resorting to intubation and mechanical ventilation.
As a nurse practitioner student, I’ve had to don all the personal protective equipment to enter the room and say, “Buddy, I’m so sorry but we can’t do anything else with external oxygen to help you — you are going to need to be placed on the ventilator. Is that all right with you?” Then I’ve listened as the patient gasped for air and said, “Yes. ... I can’t do this anymore. I’m so tired, but I’m also so scared.”
(Being placed on a ventilator, a breathing machine, means having a breathing tube placed down the windpipe to the lungs; a patient is sedated while on a ventilator.)
I have had to make phone calls, as both nurse and a nurse practitioner student, to families to tell them that we have exhausted everything we can medically do and that their loved one is not going to survive. I’ve had to tell family members — who have not been able to visit their loved one the entire time he or she has been hospitalized — that they now should come in to say goodbye.
During my last week of my clinical placement, I had to call a patient’s family to inform them he was doing worse. He was maxed out on oxygen and struggling to breathe and we needed to place him on a ventilator. As a family member told me over the phone, “I have been fearing this was going to happen. ... I’ve been trying to prepare myself but it isn’t easy.”
I watched as my preceptor (my clinical mentor) spoke with the patient to get his consent to be intubated. Two hours later, the nurse called to say the patient’s oxygen level had dropped to the 60s. Even after turning him onto his abdomen his oxygen remained in the 60s. I then sat next to the physician as he called that family again to tell them to come in and see him and say goodbye. A few hours later, he was gone.
Recently I cared for a COVID-19 patient who was on the maximum amount of oxygen. For the first 10 hours of my shift, I got to know that patient, talked with him, and learned about his life and his family. By hour seven, I had to tell him I was getting concerned because he was working so hard to breathe. I wanted to make sure someone had already discussed the possibility that he might need to be placed on a ventilator and to make sure he was OK with that, which he was.
I knew throughout the day — each time he struggled for breath as he tried to change positions — that he kept thinking of, and fearing the thought of, having to be placed on a ventilator. In the 10th hour of my shift, the doctor went in to tell him we needed to place him on the ventilator. I entered the room to prepare and I tried my best to comfort him as tears rolled down his face. I saw his fear in his eyes as he told me he didn’t get to tell his family goodbye. I tried to reassure him that this didn’t mean this was the end, that we were going to do everything to help him recover, and that I would be with him the entire time. I wanted to give him hope.
Ismael Melendez sympathizes with those who have lost a loved one to COVID-19.
Shock and loss
I have watched families as they stand in total shock outside the room as they are seeing their loved one for the first time in the hospital, sedated and unconscious, hooked up to a ventilator, multiple IVs, and sometimes additional machines like dialysis and ECMO (a life support machine that does the work of the heart and lungs) — often facedown on the bed because we have learned that people oxygenate best on their stomachs.
They enter the room to find their loved one sedated and not able to respond, and in some way they have to figure out how to say goodbye and find closure and peace.
I have tried to comfort families without being able to provide them with a hug.
I had a family member tell me, “When he tested positive for COVID he didn’t think it was that big of a deal because we all had it first and recovered fine. We kinda thought the same thing.” A few hours later, that patient died.
The lesson: You might get it and not get very sick, but that doesn’t mean the person you pass it along to will have the same luck.
And yes, health care workers are tired, and we too are getting sick. We try to support and comfort each other, and hold each other up, but it’s not easy right now.
The president reminds us that there are plenty of ventilators, but where do we go, what do we do, when there are not enough respiratory therapists, nurses and doctors to take care of those ventilators and vented patients because we are infected with the virus? What do we do when there are not enough hospital beds and people who come to the hospital for other serious illnesses need beds?
People do not stop having heart attacks, strokes, heart failure and diabetic emergencies during a pandemic. Car accidents and other traumatic injuries do not stop during a pandemic. And now we are also in flu season.
We are overwhelmed.
It’s equivalent to having a pile of daily paperwork on your desk and every day your boss dropping a 2-foot pile of additional papers on your desk that he expects you to have taken care of by the end of the day. Except our endless tasks are matters of life and death.
Defeating this monster
We all have a responsibility right now. From my perspective as a nurse, I am not a hero — I am doing my job. As a nurse I am not on the front line —I am people’s last line of defense against this monster.
So if you want to ignore the recommendations and have large gatherings for the holidays and continue to argue against masks, go ahead, but know that you are acting selfishly. And if you don’t like people calling you selfish, you’re going to have to live with it. I am calling it as I see it.
As a trauma nurse, I see people take risks all the time, living their life how they choose with the thought that “it won’t happen to me.” If you want to live your life in a way that puts your life at risk, that is your choice. But when you live your life in a way that puts other people’s lives at risk, that is, by definition, selfish.
Please think twice before you ignore the recommendations to limit your holiday celebrations to those who already live in your home. Call your extended family and/or friends — use Skype, FaceTime, Zoom, whatever! We are fortunate to have all the luxuries of technology to keep us together emotionally even when it’s better for us to be apart physically. Do not get on that plane, bus or train even if you have been planning for it for months. Please stop the memes about the cops chasing you on the freeway because you have a turkey that feeds 25 in your car — those memes aren’t funny.
Nothing about this is funny.
Until a few weeks ago I hadn’t seen my family since last December. I hadn’t hugged my mother or father, who are in good health but in their 70s, for almost a year. I saw them more times in a year when I lived 1,200 miles away than in the past year, living a short, three-hour car ride away. I got tested for COVID-19 before I went home and then quarantined for a week before visiting to be certain. I didn’t want to be the reason they got sick just so I could hug them and spend time together.
This is the first time in many years that I am off from work for both Christmas Eve and Christmas. I would love nothing more than to be able to spend that time with my family, but I will not be heading home. We are planning to have a virtual Christmas this year. I cannot avoid COVID-19; I care for COVID-19 patients constantly. I can only protect myself with PPE and pray that is enough to keep me well.
There were more than 250,000 empty seats at tables across the United States at Thanksgiving, and there probably will be more than 300,000 empty seats at Christmas. And because of COVID-19, those seats will remain empty for all the holidays to come. If you’re one of the lucky ones to not have an empty seat, do your part and keep that seat occupied (even if this year it means virtually).
Please be safe.
Please stay home.
Please wear a mask.
Please keep those you love safe by staying in your own home.
Please be part of the solution.
Please — just please — think of others as well as yourself.
Give thanks for all that you have and be grateful.
Nikkee Asashon is an intensive care unit nurse in Lancaster County.